The Brief Psychiatric Rating Scale as an acute inpatient outcome measurement tool: a pilot study

BACKGROUND

Recent guidelines for length of stay at psychiatric hospitals may have an unacceptable impact on patient outcome at discharge. A valid measurement tool is needed to evaluate significant patient change during brief hospitalization, typically 7 days, and to provide early prediction of unfavorable short-term outcome. This study examines the utility of the Brief Psychiatric Rating Scale (BPRS) as such a tool.

METHOD

During a 2-month testing period, the BPRS was administered to 87 successive adults admitted to an acute general psychiatric inpatient unit at admission, 2 days, 7 days, and weekly thereafter until discharge. Total BPRS scores and 4 subscores were used in the data analysis, which included paired t tests and correlation analyses.

RESULTS

Mean BPRS total scores demonstrate significant (p < .001) patient improvement at days 2, 7, and 14 of the hospital stay. Changes in subscores and their relationship to eventual outcome vary across diagnostic groups.

CONCLUSION

The BPRS appears to be a useful inpatient outcome measure since it is capable of demonstrating significant change during brief stays of 1 week or less. Subscale scores may provide more specific prediction of change and may help clarify outcome in individual patients who show insignificant change by total score.

Nature of the inhibition of horseradish peroxidase and mitochondrial cytochrome c oxidase by cyanyl radical

Previous studies established that the cyanyl radical ((*)CN), detected as 5,5-dimethyl-1-pyrroline N-oxide (DMPO)/(*)CN by the electron spin resonance (ESR) spin-trapping technique, can be generated by horseradish peroxidase (HRP) in the presence of hydrogen peroxide (H(2)O(2)) and by mitochondrial cytochrome c oxidase (CcO) in the absence of H(2)O(2). To investigate the mechanism of inhibition by cyanyl radical, we isolated and characterized the iron protoporphyrin IX and heme a from the reactions of CN(-) with HRP and CcO, respectively. The purified heme from the reaction mixture of HRP/H(2)O(2)/KCN was unambiguously identified as cyanoheme by the observation of the protonated molecule, (M + H)(+), of m/z = 642.9 in the matrix-assisted laser desorption/ionization (MALDI) mass spectrum. The proton NMR spectrum of the bipyridyl ferrous cyanoheme complex revealed that one of the four meso protons was missing and had been replaced with a cyanyl group, indicating that the single, heme-derived product was meso-cyanoheme. The holoenzyme of HRP from the reconstitution of meso-cyanoheme with the apoenzyme of HRP (apoHRP) showed no detectable catalytic activity. The Soret peak of cyanoheme-reconstituted apoHRP was shifted to 411 nm from the 403 nm peak of native HRP. In contrast, the heme a isolated from partially or fully inhibited CcO did not show any change in the structure of the protoporphyrin IX as indicated by its MALDI mass spectrum, which showed an (M + H)(+) of m/z = 853.6, and by its pyridine hemochromogen spectrum. However, a protein-centered radical on the CcO can be detected in the reaction of CcO with cyanide and was identified as the thiyl radical(s) based on inhibition of its formation by N-ethylmaleimide pretreatment, suggesting that the protein matrix rather than protoporphyrin IX was attacked by the cyanyl radical. In addition to the difference in heme structures between HRP and CcO, the available crystallographic data also suggested that the distinct heme environments may contribute to the different inhibition mechanisms of HRP and CcO by cyanyl radical.

Interdental distraction osteogenesis and rapid orthodontic tooth movement: a novel approach to approximate a wide alveolar cleft or bony defect

The closure of a wide alveolar cleft and fistula in cleft patients and the reconstruction of a maxillary dentoalveolar defect in traumatic patients are challenging for both orthodontists and surgeons. This is due to the difficulty in achieving complete closure by using local attached gingiva and the great volume of bone required for the graft. In this article, the authors propose using interdental distraction osteogenesis to create a segment of new alveolar bone and attached gingiva for the complete approximation of a wide alveolar cleft/fistula and the reconstruction of a maxillary dentoalveolar defect. They performed this procedure on one patient with a traumatic maxillary dentoalveolar defect and 10 patients with unilateral or bilateral cleft lips and palates who had varied dentoalveolar clefts/fistulas. Interdental and maxillary osteotomies were performed on one side of the dental arch by the cleft or defect. After a latency period of 3 days, the osteotomized distal segment of the dental arch was then distracted and transported toward the cleft or defect by using a toothborne intraoral distraction device. The alveoli and gingivae on both ends of the cleft or defect were approximated after distraction osteogenesis. The need for extensive alveolar bone grafting was eliminated. A segment of new edentulous alveolus and attached gingiva was created interdentally at a site distant to the cleft or defect. In the cleft patients, teeth were moved orthodontically into the regenerate (newly formed alveolar bone) dental crowding 1 week after distraction. The orthodontic tooth movement was rapidly completed in 3 months, and the edentulous space was eliminated. Interdental distraction osteogenesis minimizes an alveolar cleft/fistula and helps reconstruct a maxillary dentoalveolar defect by approximating the native alveoli and gingivae; it also creates new alveolar bone and gingiva for rapid orthodontic tooth movement.

The c-Jun N-terminal kinase pathway and apoptotic signaling (review)

The c-Jun N-terminal kinase (JNK) group of mitogen-activated protein kinases (MAPKs) is activated in mammalian cells by environmental stress, pro-inflammatory cytokines, and mitogenic stimuli. Biochemical and genetic studies demonstrate that JNK regulates the activities of many transcription factors, and that the JNK pathway is required for the regulation of inflammatory responses, cell proliferation, and apoptosis. The involvement of JNK in apoptotic cell death is particularly intriguing, and has been actively studied in recent years. An improved understanding of JNK-mediated apoptotic signaling may provide novel strategies in prevention and treatment of cancers.

Application of endoscope in zygomatic fracture repair

The endoscope has been used to visualise the upper face and brow in aesthetic facial surgery which is performed without a coronal incision. We applied these principles to repair zygomatic fractures with the aid of a 4 mm, 30 degree telescope inserted through a small temporal incision. Fracture sites at the zygomatic arch and the zygomaticofrontal suture were exposed and fixed with miniplates under endoscopic control. This technique was used in 15 consecutive patients including 2 with isolated zygomatic arch comminuted fractures and 13 having displaced zygomatic fractures with segmental, displaced zygomatic arch fractures. Nine patients were men and six patients were women with a mean age of 35 years. Three patients had associated mandibular fractures. The periods of follow-up ranged from 3 to 22 months. Two patients developed transient frontal nerve palsy which recovered within 2 months. One patient had mild temporal hollowing on the side of the facial fracture. All patients achieved the adequate anatomic reduction and satisfactory malar symmetry. There has been no case of chewing problems, cheek numbness or progressive enophthalmos developing postoperatively. Application of the endoscope in zygomatic fracture repair minimises the scalp scar, avoids forehead numbness, provides a comfortable postoperative recovery and shortens hospital stay. Careful preoperative evaluation and proper surgical technique are mandatory for achieving optimal results in selected patients.

Social support and life adjustment for teenagers with cleft lip and palate in Taiwan

BACKGROUND

The teenage years (13-19 years) are a critical period for psychosocial development. Therefore, social support and life adjustment for teenagers with cleft lip/palate were chosen for investigation.

METHODS

The sample survey included 101 cleft patients randomly selected from the Chang Gung Craniofacial Center, and 101 non-cleft controls selected from local middle and high schools for comparison. Questionnaires were used to evaluate the social support and life adjustment scales. Items of social support were subdivided into social activities, social service, and psychological support. Items of life adjustment were subdivided into social, psychological, and physical adjustments.

RESULTS

The coefficients of alpha reliability were high at 0.9294 for social support, and 0.9389 for life adjustment. The results show that personal factors, family factors, and treatment status do not influence social support or life adjustment in either group; however, gender does. In the control group, non-cleft males had better social support and life adjustment than did females. Such a difference was not observed in the cleft group. Both groups received the same social support. The cleft teenagers have a significantly lower level of life adjustment. The association between the social support and life adjustment is high in both groups.

CONCLUSION

The cleft group has a lower level of life adjustment. There is a positive relationship between social support and life adjustment. More social support is required for the cleft group in order to improve their level of life adjustment.

Two-dimensional visible/near-infrared correlation spectroscopy study of thermal treatment of chicken meats

The thermal treatment of chicken meats was investigated by generalized 2D visible/NIR correlation spectroscopy. Synchronous 2D visible correlation analysis revealed that there are at least two bands around 445 and 560 nm, decreasing in intensity with cooking time. The corresponding asynchronous spectrum indicated that the spectral intensity reduction of the two bands occurs before the intensity variation of the 475, 520, and 585 nm bands. It suggested that the 445 and 560 nm bands be assigned to deoxymyoglobin and oxymyoglobin, respectively, and at least one of the 475, 520, and 585 nm bands assigned to the denatured species (metmyoglobin) of myoglobin. Also, the asynchronous 2D NIR correlation spectrum indicated that C-H fractions are easily oxidized. In addition, strong correlation peaks correlating the bands in the visible, SW-NIR, and NIR spectral regions were observed and discussed.

Butyrate-inducible elements in the human gamma-globin promoter

OBJECTIVE

Several agents including hydroxyurea, erythropoietin and butyric acid have been shown to reactivate gamma gene expression during adult stage development by unknown molecular mechanisms. In addition to inhibiting the enzyme histone deacetylase, butyrate may modulate transcription factor binding to specific DNA sequences defined as butyrate response elements (BREs). The purpose of this study was to identify promoter sequences involved in gamma gene activation by butyrate using truncation mutants in stable cell lines.

MATERIALS AND METHODS

A detailed analysis of Agamma gene activation in the presence of alpha-aminobutyric acid and sodium butyrate was completed in stable mouse erythroleukemia (MEL) cell pools established with seven Agamma promoter truncation mutants. Functional studies were performed in a transient assay system followed by gel mobility shift assays to define protein binding patterns and to demonstrate transcription factor interactions in the gamma promoter BRE.

RESULTS

Agamma promoter analysis in stable MEL cell pools revealed BREs between nucleotide-141 and -201, and nucleotide-822 and -893 (gammaBRE). The gammaBRE required the minimal Agamma promoter (-201 to +36) to stimulate gene expression. We observed a 6.1-fold (p < 0.05) increase in CAT activity for the minimal Agamma promoter alone compared with an 11.5-fold (p < 0.05) increase when the gamma promoter was combined with the -822 to -893 fragment. Protein binding studies demonstrated altered protein-DNA interactions in the gammaBRE after butyrate induction. The pattern for binding observed suggest both negative- and positive-acting transcription factors may interact in this region.

CONCLUSION

The data supports the -822 to -893 region as a DNA regulatory element that contributes to Agamma gene inducibility by butyrate.

Economic feasibility analysis for an automated on-line poultry inspection technology

On-line carcass inspection of chickens in the United States is currently done using visual (organoleptic) methods. Inspectors from the USDA Food Safety and Inspection Service (FSIS) inspect the viscera and carcass and, for older birds, the heads using a sequence of observations and palpations at a postmortem inspection station. The streamlined inspection system (SIS) and the new line speed inspection system (NELS) are the most prevalent visual inspection methods. The former has a line speed of 70 birds/min with two inspectors per line, and the latter has a line speed of 91 birds/min requiring three inspectors per line. Both inspection methods are labor intensive and prone to human error. In addition, the speed of the slaughter line is dictated by the number of birds per minute that can be inspected by FSIS inspectors. Ninety-one birds/min is currently the maximum visual inspection line speed allowed under current Federal regulations. This study evaluates the economic benefits of using automated inspection in place of visual inspection from the perspective of both the slaughter plant and FSIS. The results indicate that FSIS and slaughter plants would gain economic benefits by using automated inspection in place of visual inspection. The economic benefits to FSIS would accrue from labor savings, whereas the economic benefits to slaughter plants would accrue primarily from increased throughput from faster inspection line speeds.

Analysis of coptisine, berberine and palmatine in adulterated Chinese medicine by capillary electrophoresis-electrospray ion trap mass spectrometry

Chinese medicine preparations contaminated with coptisine, berberine and palmatine were studied by capillary electrophoresis-electrospray ion trap mass spectrometry. The dubious adulterants were identified by their retention times, molecular ions and specific fragment ions produced from collision induced dissociation. The results showed that, in comparison with CE-UV and capillary electrophoresis-electrospray mass spectrometry (CE-ESI-MS), more reliable identification could be achieved with CE-ESI-MS-MS using ion trap mass spectrometry.

Caspase-mediated cleavage and functional changes of hematopoietic progenitor kinase 1 (HPK1)

Activation of c-Jun N-terminal kinase (JNK) by Fas ligation is caspase-dependent, suggesting that caspases may regulate activators of the JNK pathway. Here, we report that an upstream activator of JNK, hematopoietic progenitor kinase 1 (HPK1), was cleaved during apoptosis. Cleavage of HPK1 was blocked by peptide inhibitors for caspases. HPK1 was efficiently processed by recombinant caspase 3 in vitro. A conserved caspase recognition site, DDVD (amino acids 382 - 385), was found in the HPK1 protein sequence. By testing HPK1 proteins with in vivo and in vitro cleavage assays, we showed that aspartic acid residue 385 is the target for caspases. HPK1 cleavage separated the amino N-terminal kinase domain from the carboxyl C-terminal regulatory domain, and enhanced HPK1 kinase activity. Unlike the full-length HPK1, the N-terminal cleaved product failed to bind adaptor molecules Grb2 (growth factor receptor-bound protein 2) and Crk (CT10 regulator of kinase). The C-terminal fragment, although having three proline-rich domains, bound to Grb2 and Crk less efficiently than the full-length HPK1 protein. Taken together, the cleavage of HPK1 by caspase profoundly changed its biochemical properties.

c-Jun N-terminal kinase mediates apoptotic signaling induced by N-(4-hydroxyphenyl)retinamide

N-(4-Hydroxyphenyl)retinamide (4-HPR), a retinoic acid analog, induces apoptosis in several cell types. The mechanism by which 4-HPR initiates apoptosis remains poorly understood. We examined the effects of 4-HPR on two prostate carcinoma cell lines, LNCaP (an androgen-sensitive, p53(+/+) cell line) and PC-3 (an androgen-insensitive, p53(-/-) cell line). 4-HPR caused sustained c-Jun N-terminal kinase (JNK) activation and apoptosis in LNCaP cells but not in PC-3 cells at the dosages tested. Activation of JNK by 4-HPR was independent of caspases because a pan-caspase inhibitor failed to suppress JNK activation. Ultraviolet-C and gamma-radiation induced JNK activation in both LNCaP and PC-3 cells, suggesting that the failure of PC-3 cells to respond to 4-HPR was due to defects upstream of the JNK pathway. Furthermore, gamma-radiation-induced JNK activation was suppressed by an antioxidant, but 4-HPR-induced JNK activation was not, indicating that these two stimuli induced JNK activation through different mechanisms. Forced expression of JNK1, but not a JNK1 mutant, caused apoptosis in both LNCaP and PC-3 cells, suggesting that p53 is not required for JNK-mediated apoptosis. 4-HPR-induced apoptosis in LNCaP cells was suppressed by curcumin, which inhibits JNK activation. Expression of dominant-negative mutants in the JNK pathway also inhibited 4-HPR-induced apoptosis in human embryonic kidney 293 cells. Collectively, these results suggest that the JNK pathway mediates 4-HPR-induced apoptotic signaling.

A comparative study of various fixation methods for mandibular fracture

BACKGROUND

Internal rigid fixation for mandibular fractures has been recognized as a reliable method for obtaining osteosynthesis. It may allow for early active physiotherapy and resumption of normal function. However, few studies have compared the various fixation methods.

METHODS

From January 1993 through December 1997, 101 patients with mandibular fractures, who were selected for study, received treatment using various fixation methods at the Craniofacial Center, Chang Gung Memorial Hospital. The fixation methods included plate fixation in 44 patients, lag screw fixation in 30, combined plate and lag screw fixation in 15, and wire fixation in 12. Clinical data assessment was performed by reviewing hospital records. For assessment of the long-term surgical results, the patients were asked to complete a questionnaire including questions which specifically targeted history regarding occlusion, mastication, facial asymmetry, width of mouth opening, and general appearance.

RESULTS

The outcome assessment showed statistically different results among the groups. The wire group required intermaxillary fixation more often and for a longer duration compared to the groups using plates and/or lag screws. The plate, lag screw, and combined plate and lag screw fixation groups had better total outcome scores, in particular for long-term dental occlusion and mastication function.

CONCLUSION

This study shows that for mandible fractures, the more rigid types of fixation methods, i.e., plates and screws or lag screws, can offer better short and long-term outcomes.

Assessment of orientation: relationship between informant report and direct measures

Although informant reports of everyday functioning are often used in dementia assessments, the actual correspondence between such indirect reports of functioning and actual performance has not been examined. Orientation results on the Dementia Questionnaire for Mentally Retarded Persons were compared to those obtained in direct assessment of orientation of 138 adults with mental retardation. Fair to good agreement was found between informant report and direct assessment. However, for some orientation items, nonverbal IQ, cause of mental retardation, and age affected the level of agreement. Thus, both informant report and direct measures of orientation are necessary in dementia assessments, and further work is needed on informant scale validation.

Airway obstruction in severe syndromic craniosynostosis

Airway obstruction is frequent in patients with severe syndromic craniosynostosis, and must be treated for successful, complete care. The purpose of this study was to evaluate the incidence and the management of airway obstruction in patients with severe craniosynostosis. All patients with complex syndromic craniosynostosis at Chang Gung Craniofacial Center were evaluated retrospectively. Criteria for inclusion of patients were the presence of adequate follow-up and documentation. A total of 40 patients were included, of whom 13 had Apert's syndrome and 27 had Crouzon's disease. Clinical symptoms and signs related to airway obstruction and its treatment were evaluated carefully, and were verified further by telephone inquiry. The status of the airway was categorized into one of three groups: no obstruction; mild obstruction, for which positioning and medical treatment were needed; and severe obstruction, for which surgical intervention was needed. The results showed that 24 patients (60%) did not have airway obstruction, 11 patients (27.5%) had mild obstruction, and 5 patients (12.5%) had severe obstruction. There was no significant difference in the distribution of airway status between patients with Apert's syndrome and Crouzon's disease. Causes for the 5 patients with severe obstruction were midface hypoplasia, lower airway obstruction, tonsillar and adenoid hypertrophy, and choanal atresia. Tracheostomy was performed to control airway in 3 patients, and 1 patient died. Midface anterior distraction helped to decannulate 1 patient. In conclusion, airway obstruction was observed in 40% of patients with severe craniosynostotic syndromes. Most of them could be managed successfully with conservative or medical treatment, and surgical intervention should be considered on the basis of each patient's individual condition.

The role of multiple segment osteotomies in orthognathic surgery

Multiple segment orthognathic (MSO) surgery is an effective approach to deal with a wide range of dento-facial deformities that have occlusal problems. The indications for MSO surgery were patients with dentofacial deformities and malocclusion requiring stable correction within a short overall treatment period. From 1991 to 1998, 107 patients had MSO orthognathic procedures done at Chang Gung Memorial Hospital for maxillary protrusion/deformity (34 cases), maxillary protrusion and mandibular prognathism (69 cases), and non-cleft maxillary retrusion (4 cases). Follow up period ranged from 6 months to 7 years and results showed stability in movements with only 3 complications. The average overall treatment time was approximately 15 months. Our experience with 107 consecutive patients have shown the results of MSO surgery to be good and the procedure safe with no tooth or segment loss.

Combining single- and double-tooth osteotomies with traditional orthognathic surgery

Combining large-segment orthognathic surgery and unitooth or small-segment surgery is an effective approach to deal with a wide range of dentofacial deformities that have minor to severe occlusal problems. The indications for combining single- or double-tooth osteotomies with traditional orthognathic surgery were patients with dentofacial deformities and malocclusion requiring stable correction within a short overall treatment period. From 1991 to 1998, a total of 36 patients underwent combination single- or double-tooth-segment osteotomy with traditional orthognathic procedures performed at Chang Gung Memorial Hospital. The indications for surgery were maxillary protrusion (N = 5), bimaxillary protrusion (N = 19), mandibular prognathism with maxillary protrusion (N = 11), and noncleft maxillary retrusion (N = 1). The types of osteotomies performed were the Le Fort I, the anterior segmental osteotomies of the maxilla or the mandible, the palatal split, and the posterior segment in combination with single-tooth or double-tooth segments. Follow-up ranged from 12 months to 6 years and showed stability in the movements with no complications. There was no loss of any "osteotomized" segment. The average overall treatment time was approximately 18 months--5 months preoperative and 13 months postoperative orthodontic treatment. This was at least 6 months shorter in duration compared with traditional orthognathic surgery. Combining traditional orthognathic surgery with single- or double-tooth segments allows us to treat complex dentofacial deformities in the vertical, transverse, and sagittal dimensions with differential repositioning of all segments, either major or minor, simultaneously. The authors' experience with 36 consecutive patients evidence good results and demonstrate the procedure to be safe with minimal complications.

Maxillary growth after palatal denudation: an animal experiment

BACKGROUND

Palate surgery at an early age may cause retardation of maxillary growth. The second intention healing of the raw bone surface created on the palate is considered to be the cause of the growth retardation. The animal experiment in this study was designed to evaluate this effect.

METHODS

Four-week-old Sprague-Dawley rats were divided into 3 groups. In the first group, a strip of mucoperiosteum was excised on both sides of the hard palate. A second group of rats received a sham surgery in which bilateral mucoperiosteal flaps were raised and redraped. The third group served as controls with no surgery. Flap elevation with and without excision was performed under an operative microscope to facilitate the delicate manipulation of tissue and to avoid injury to the underlying bone. The animals were killed 11 weeks later and the skulls were prepared for measurements, which included the palatal inter-molar width, maxillary height, and maxillary length.

RESULTS

The results revealed statistically significant decreases in palatal width and maxillary length in the experimental group (excision of mucoperiosteum). No differences were observed in the vertical height of the maxilla.

CONCLUSION

This study confirms that surgically created bone denudation of the palate causes maxillary growth disturbances.

Electron spin resonance investigation of the cyanyl and azidyl radical formation by cytochrome c oxidase

Cyanide (CN(-)) is a frequently used inhibitor of mitochondrial respiration due to its binding to the ferric heme a(3) of cytochrome c oxidase (CcO). As-isolated CcO oxidized cyanide to the cyanyl radical ((.)CN) that was detected, using the ESR spin-trapping technique, as the 5,5-dimethyl-1-pyrroline N-oxide (DMPO)/(.)CN radical adduct. The enzymatic conversion of cyanide to the cyanyl radical by CcO was time-dependent but not affected by azide (N(3)(-)). The small but variable amounts of compound P present in the as-isolated CcO accounted for this one-electron oxidation of cyanide to the cyanyl radical. In contrast, as-isolated CcO exhibited little ability to catalyze the oxidation of azide, presumably because of azide's lower affinity for the CcO. However, the DMPO/(.)N(3) radical adduct was readily detected when H(2)O(2) was included in the system. The results presented here indicate the need to re-evaluate oxidative stress in mitochondria "chemical hypoxia" induced by cyanide or azide to account for the presence of highly reactive free radicals.

Multiple-segment osteotomy in maxillofacial surgery

Multiple-segment osteotomy is defined as an osteotomy that divides the tooth-bearing arch of the maxilla or mandible into three or more segments. Combining large-segment orthognathic surgery and unitooth or small-segment surgery is an effective approach for dealing with a wide range of dentofacial deformities with occlusal problems. The indications for a multiple-segment osteotomy included dentofacial deformities and malocclusions requiring stable correction within a short overall treatment period. From 1991 to 1997, a total of 85 patients had multiple-segment osteotomy orthognathic procedures performed at Chang Gung Memorial Hospital. The indications for surgery were maxillary protrusion/deformity (31 patients), mandibular prognathism (51 patients), and noncleft maxillary retrusion (three patients). The types of osteotomies performed were Le Fort I, anterior segmental osteotomies of the maxilla or the mandible, palatal split, posterior segment, and unitooth or double-tooth segments. Follow-up ranged from 6 months to 7 years; stability was seen in movements, with only three complications (one partial gingival loss and two inferior mental paresthesias). No osteotomized segments were lost. The average overall treatment time was approximately 15 months, including 3 to 6 months of preoperative and 9 to 12 months of postoperative orthodontic treatment. This is at least 6 months shorter than traditional orthognathic surgery. Experience with 85 consecutive patients has shown that the results are good and the procedure is safe, with minimal complications.

Temporomandibular joint reconstruction in children using costochondral grafts

PURPOSE

The aim of this study was to evaluate the postoperative growth of the mandible after reconstruction of the condylar process using costochondral grafts in children.

PATIENTS AND METHODS

Temporomandibular joint (TMJ) ankylosis was surgically treated and the joint reconstructed with a costochondral graft (CCG) in two boys and eight girls with a mean age of 7.4 years. Two children had bilateral ankylosis. Postoperative changes and craniofacial growth were monitored by lateral and posteroanterior (PA) cephalograms annually from 2 to 6 years (mean of 4 years).

RESULTS

Postoperatively, in the eight children with unilateral TMJ reconstruction, the mandible (Co-Gn) grew an average of 14.7 mm in length on the affected side and 15.1 mm on the nonaffected side; ramus length (Co-Go) increased an average of 7.1 mm on the affected side and 7.3 mm on the nonaffected side. However, in five of the children the chin progressively deviated toward the nonaffected side after TMJ reconstruction. The CCGs tended to have a more vertically directed condylar growth pattern and a more laterally positioned condyle. In the two cases with bilateral TMJ reconstruction, the CCGs grew until there was a mandibular prognathism that required orthognathic surgery to set back the mandible.

CONCLUSIONS

Using CCGs to reconstruct TMJ ankylosis in children provides a functional condyle with growth potential. However, there is a possibility of excessive growth of the graft, resulting in deviation of the chin and mandibular prognathism years later.

Structural studies of symmetric DNA undecamers containing non-symmetrical sheared (PuGAPu):(PyGAPy) motifs

Interstrand purine-purine stacks originate from tandem sheared purine.purine pairing and represent one of the most important motifs in both DNA and RNA structures. Several RNA and DNA structures, solved recently in both solution and the solid state, contain these special motifs, which greatly increase the structural diversity of nucleic acid molecules. The direct evidence for the sheared purine-purine pairing at neutral pH in solution remains, however, elusive. In this manuscript, we have used high resolution NMR methods to study a series of symmetrical DNA duplexes containing two non-symmetrical 5'-(PuGAPu)/(PyGAPy)-3' motifs. Many strong- and medium-strength NOEs across the G.A base pair were detected in the H2O-NOESY spectra collected at a relatively low temperature (-5 degrees C). These NOEs, especially those from A-6NH2 to G-H1', G-H4', and G-2NH2, clearly define the proposed side-by-side sheared G.A pairing nature. Another interesting feature is the strong NOEs exhibited by the unpaired G-imino proton in the G.A pair to its own G-2NH2, which implies that G-2NH2 is involved in H-bonding with a base in the minor groove edge. The finding that non-symmetrical (PuGAPu):(PyGAPy) motif also form similarly stable structures loosens the requirement for a more restricted (PyGAPu)2 motif in forming the interstrand purine-purine stacks.

Palatoalveolar outcome at 18 months following simultaneous primary cleft lip repair and posterior palatoplasty

It is frequently reported that early repair of the soft palate induces narrowing of the remaining palatal cleft and thus facilitates later hard palate closure. However, to the best of our knowledge, there have been no comparative studies to test this hypothesis. The purpose of this retrospective study was to evaluate the change of palatoalveolar morphology following primary lip repair and posterior palatoplasty. Dental plaster models of patients with complete unilateral cleft of lip and palate (UCLP) were used to measure the width of the cleft and palatal arch. Twenty-six patients received simple posterior palatoplasty (PP group) simultaneous with primary lip repair, and 20 patients did not (NPP group). The dental models included one preoperative cast at 2 months (T1) and two or three casts at 6 (T2), 12 (T3), and 18 (T4) months before final palate closure. The linear measurements performed were width of alveolar cleft (Ca); width of palatal cleft between the canines (Cc), molars (Cm), and tuberosities (Ct); the palatal arch distance between the canines (Dc); the widest distance between molars (Dm) and the tuberosities (Dt); and the palatal height between the canines (Hc) and tuberosities (Ht). The raw measurements and the calculated cleft-to-arch ratios of Cc/Dc, Cm/Dm, and Ct/Dt were compared between the two groups. The results showed gradual narrowing of the width of cleft from T1 to T4. Narrowing of alveolar cleft width (Ca) from T1 to T2 was dramatic. The palatal arch (Dc, Dm, Dt) showed no change to mild increase in width. The cleft-to-arch ratios decreased with time. The palatal height remained the same or slightly increased over time. There were no significant differences observed between the PP and NPP groups among these measurements except for the Ct and Ct/Dt at T4. In conclusion, after initial lip repair, there was a decrease of the width of cleft in patients with complete UCLP during the 18-month period, and simple posterior palatoplasty did not further narrow the cleft nor influence palatal arch development.

Three-dimensional computed tomographic analysis of the primary nasal deformity in 3-month-old infants with complete unilateral cleft lip and palate

The purpose of this study was to analyze the geometry of the primary cleft lip nasal deformity using three-dimensional computerized tomography in a group of 3-month-old infants with complete unilateral cleft lip and palate before surgical intervention. Coordinates and axes were reconfigured after the three-dimensional image was oriented into neutral position (Frankfurt horizontal, true anteroposterior, and vertical midline). Display and measurement of skin surface and osseous tissues were achieved by adjusting the computed tomographic thresholds. S-N, N-ANS, S-N-O, and S-N-ANS were measured from true lateral views. Biorbital (LO-LO), interorbital (MO-MO), intercanthal (en-en), and nasal (al-al) widths were measured from the anteroposterior view. The bony alveolar cleft width was measured from the inferior view. The study group was divided into two groups on the basis of skeletal alveolar cleft width: six patients with clefts narrower than 10 mm and six patients with clefts wider than 10 mm. Only the S-N-ANS angle differed between the two groups, i.e., it was greater in the group with the wider clefts (p < 0.05). Coordinates of six landmarks at the base of the nose [sellion (se), subnasale (sn), cleft-side and noncleft-side subalare (sbal-cl and sbal-ncl), and the most posterior point on the lateral piriform margins (PPA-CL and PPA-NCL)] were obtained for analysis of the nasal deformity. On average, the subnasale point was anterior to sellion and deviated to the noncleft side; the cleft-side sbal point was more medial, posterior, and inferior than the noncleft-side sbal point; and the PPA point on the cleft-side piriform margin was more lateral, posterior, and inferior than the PPA point on the noncleft side. These discrepancies were not universally observed. However, in all patients, four findings were observed without exception (p < 0.01): (1) subnasale (sn) was deviated to the noncleft side (mean distance from midline, 5.0 mm; range, 2 to 9.5 mm), (2) the cleft-side alar base (sbal-cl) was more posterior than the noncleft-side alar base (sbal-ncl) (mean difference, 3.6 mm; range, 1 to 5.5 mm), (3) the noncleft-side alar base (sbal-ncl) was further from the midline than the cleft-side alar base (sbal-cl) (mean difference in lateral distances of sbal-ncl and sbal-cl from the midline, 2.8 mm; range, 0.5 to 7 mm), and (4) the cleft-side piriform margin (PPA-CL) was more posterior than the noncleft side piriform margin (PPA-NCL) (mean difference, 2.1 mm; range, 0.5 to 4 mm). In conclusion, the nasal deformity in unilateral cleft lip and palate that has not been operated on is characterized by these four features and increased S-N-ANS angle with increased alveolar cleft width.

Mandibular lengthening by distraction osteogenesis in children--a one-year follow-up study

OBJECTIVE

The present study was undertaken to document whether mandibular length could be increased by distraction osteogenesis in children and what happens to the mandibular position 1 year after the distraction.

METHODS

Five patients with hemifacial microsomia (four unilateral, one bilateral) had distraction osteogenesis performed to lengthen the mandible. All patients had cephalometric and panoramic radiographs obtained before and 3, 6, and 12 months after the distraction osteogenesis.

RESULTS

The total mandibular length (Co-Gn) on the affected side was increased by 11.2 mm after the distraction and remained stable during a 1-year observation period. However, the increased mandibular length tended to move the chin downward (8 mm) more than forward (2 mm) during the same period.

CONCLUSIONS

Distraction osteogensis can be used to lengthen the hypoplastic mandible. However, most of the increased mandibular length moved the chin downward more than forward.